摘要
目的 :探讨肝脏移植的切取及移植手术方法。方法 :采用背驮式的病肝切取要求 ,首先分离第 1肝门 ,将肝蒂解剖至分叉以上 ,然后近肝游离肝周韧带 ,保留肝后下腔静脉 (IVC)和第 2肝门的 3支肝静脉 ,第 3肝门的肝短静脉应细心结扎 (或缝扎 )离断。供肝的切取 :各管道系统保留足够长度 ,避免第 1肝门分离 ,热缺血时间在 10min以内。背驮式植肝技术 :供肝上IVC与肝左中静脉供干支的端端吻合。供肝门静脉与受体门静脉端端吻合。术后采用FK5 0 6、酶酚酸脂 (MMF)抗排斥治疗。结果 :供肝切取 10例均成功 ,热缺血时间在 10min之内。 1例肝豆状核变性 (Wilson)患者 ,行背驮式肝移植成功 ,随访 7个月 ,肝功能及血铜蓝蛋白正常。结论 :掌握肝脏系统的解剖基础 ,有利于供肝的切取及病肝的切除 ,肝脏移植是唯一能挽救终末期肝病病人生命的方法 ,新型免疫抑制剂可预防移植肝排斥反应。
Objective:To explore the excision and transplantation techniques of liver allograft.Methods:According to the piggyback transplantation excision demands of diseased liver,we dissociated the first hepatic portal first,anatomized the hepatic pedicel to the furcation,then dissociated the ligs around liver.The IVC post liver and three hepatic veins of second hepatic portal were retained.The breivena of the third hepatic portal should be ligated(or sutured)and then broke.As for the excision of donor′s hepatic,enough length shold be lefted in each pipe system.The first hepatic portal dissociation should be avoided.The heat ischemia should be no longer than 10 mimutes.As for piggyback planting technique,Donor′s IVC above liver and hepatica left median vein should be anastomosed end to end.Anastomosed donor′s and recipient′s portal vein end to end.FK506 MMF were used in post transplantation immunosuppressive therapy.Results:Excision of donor′s live successed in 10 cases,and the heat ischermia were no longer than 10 minutes.The piggyback orthotopic liver transplantation successed on a patient of Wilson′s disease.Liver function and blood copper protein were normal during 7 months after transplantation.Conclusions:Understanding of hepatic systematic anatomy is helpufl to the excision of donor′s and recipient′s liver.Liver transplantation is a feasible and viable treatment for patients with endstage hepatic disease.Advanced immunosuppressant can prevent the rejection of liver allograft.
出处
《中国临床解剖学杂志》
CSCD
北大核心
2000年第4期377-380,共4页
Chinese Journal of Clinical Anatomy
关键词
肝移植
解剖学
背驮式技术
Liver transplantation Anatomy Piggyback technique
